1. First step: rest and physical therapy
As we age, the pathological process of knee joint proliferation and degeneration is essentially irreversible. Early treatment can reduce symptoms, relieve pain, stop the vicious cycle, increase joint mobility, and slow the process of its development.
Rest is an important part of the treatment of osteoarthritis of the knee and is used throughout every treatment process. It is important to protect the joints in daily life and avoid excessive joint activity or injury. One of the things I often say to patients in my clinic is: from now on, take a car or bike when you go out, and find a stool to sit on when you get to where you are, don’t stand there and watch.
Physical therapy, including infrared and microwave therapy, can also relieve symptoms to some extent.
If rest and physical therapy do not relieve the symptoms, we must enter the second step of treatment.
2.Second step: oral medication
Western medicine treatment: anti-inflammatory and analgesic drugs (oral or topical); cartilage nutrients.
Chinese medicine treatment: Chinese medicines and tonics that strengthen the liver and kidney, strengthen the muscles and bones, and activate blood circulation and remove blood stasis. External hot compresses, fumigation, soaking, and patching of Chinese herbs are also available.
If the symptoms cannot be relieved, or there is a digestive reaction after taking the medicine, combined with other diseases that cannot take medicine, we should enter the third step of treatment.
3.The third step: joint cavity injection
Joint cavity injection means to inject cartilage nourishing, anti-inflammatory and analgesic drugs into the joint cavity to lubricate the joint and protect the joint cartilage by using its rheological properties. We use the “triple injection” knee joint cavity injection to relieve some of the patients’ symptoms for a period of time.
If the symptoms are not relieved after a course of injections (once a week, five times in total), or if the patient relapses after stopping the medication for a short period of time, we will proceed to the fourth step of treatment.
4. Step 4: Minimally invasive surgery
(1) Arthroscopic surgery.
Arthroscopic surgery can perform joint flushing and cleaning, remove osteochondral debris, free bodies and various inflammatory and pain-causing factors; dilute cartilage-degrading enzymes in the joint, remove collagen antibodies, slow down autoimmune reactions, reduce synovial inflammation, eliminate synovial edema, and reduce the internal pressure of the knee joint while exerting physical effects.
Arthroscopy is now more commonly used, but still cannot fundamentally achieve a cure for osteoarthritis. It is mainly indicated for patients in their early and middle 50s with combined synovitis and joint effusion. For older patients with severe cartilage destruction and hyperplasia in the joint, the postoperative effect is poorer in advanced patients with nearly lost joint space.
(2) Proximal fibular osteotomy.
In clinical practice, the subsidence of the medial tibial plateau significantly lower than the lateral plateau is commonly seen on X-ray and CT images in patients with medial compartment osteoarthritis of the knee joint. Studies have concluded that bone loss and osteoporosis are responsible for the development of osteoarthritis of the knee. Uneven settlement of the tibial plateau due to fibular support is an important factor in the development and progression of osteoarthritis of the medial compartment of the knee. This is the latest theory of uneven settlement of the knee joint, and it is based on this theory that proximal fibular osteotomy is used to treat patients with medial compartment osteoarthritis of the knee. It has been widely performed nationwide and is also being performed in Asian countries such as Korea and Japan. The procedure is streamlined, less expensive, less traumatic, faster healing, and does not require strenuous rehabilitation, and can be done in patients of advanced age with underlying disease.
It is suitable for patients with the following.
1. Those whose clinical presentation is dominated by medial interval lesions.
(1) Narrowing of the medial compartment of the knee joint (shown on X-ray).
(2) Pain in the medial compartment of the knee as the main symptom (may be active pain, resting pain, or acupressure pain).
(3) The cartilage of the medial knee joint is damaged (MRI).
(2) The presence of internal derangement of the knee as measured by lower extremity force lines on weight-bearing radiographs.
Not applicable to patients with.
1, Knee valgus deformity with narrowing of the lateral space and pain.
2, rheumatoid arthritis, septic arthritis and other joint diseases.
3.History of trauma, injury or rupture of the major ligaments of the knee joint.
If the symptoms cannot be relieved after minimally invasive surgery, or if the patient is not suitable for minimally invasive surgery, he/she should enter the fifth step of treatment.
5. Step 5: Artificial joint replacement
Applicable to patients with the following.
(1) Severe destruction of joint surface bone and cartilage.
(2) with moderate to severe persistent pain.
(3) Severe deformity of the joint.
(4) Severe limitation of joint function.
In advanced stages of osteoarthritis, persistent joint pain, joint deformity, and even inability to care for oneself may occur. At this time, it is necessary to undergo artificial joint replacement. This can correct the deformity, significantly reduce symptoms, and improve joint function, allowing for pain-free walking. Arthroplasty is an increasingly mature surgical technique that is not very invasive, has a wide range of indications, and has a long service life for the newly developed joints. They can even be “rebuilt” after several years of use. Therefore, it can be said to be one of the greatest breakthroughs in orthopedic surgery in the last century.